腓肠神经营养血管复合皮瓣一期修复跟腱区软组织缺损并感染

目的探讨应用腓肠神经营养血管远端蒂肌腱筋膜复合皮瓣修复跟腱区复杂软组织缺损并感染的手术方法和临床疗效。方法回顾性分析我科白2005年7月至2011年11月收治的13例跟腱区复杂软组织缺损患者的临床资料，其中男10例，女3例；年龄11～41岁，平均19岁；皮瓣面积14cm×8cm～18cm×10cm，均采用腓肠神经营养血管远端蒂肌腱筋膜复合皮瓣一期覆盖创面并修复跟腱缺损。结果随访2个月～2年，13例皮瓣术后均全部成活，2例皮瓣蒂部浅层坏死，4例皮瓣远端边缘散在浅层坏死，均经短期换药后愈合，患踝及小腿外形满意，提踵有力，踝关节功能基本正常，负重及行走不痛，无跛行，AOFAS评分88分，根据ArnerLindholm评定标准进行疗效评价，优9例，良4例，优良率100％。结论腓肠神经营养血管远端蒂肌腱筋膜复合皮瓣血供可靠，操作简单，能够在修复创面的同时修复重建跟腱的连续性和功能，是修复跟腱区复杂软组织缺损的理想方法。

Distally Based Sural Nerve Nutrient Vessel Fasciocutaneous Compound Flap for the Treatment of the Complex Soft Tissue Defects of Achilles Tendon

Abstract：Objective To investigate the surgical methods and clinical effects of distally based sural nerve nutrient vessel fasciocutaneous compound flap for the treatment of the combined defects of the achilles tendon and the overly ing soft tissue. Methods Clinical data of 52 cases of the lower leg,ankle and foot soft tissue defects in our department from January 2005 to June 2009 were retrospectively analyzed. The patients included 27 males and 25 females ,with an average of 31 years （range from 17 to 41 years）. The areas of flaps were from 5 crux 3 cm to 20 cmX 14 cm. All the cases were treated using distally based sural nerve nutrient vessel fasciocutaneous compound flap. Results 49 flaps of 52 cases were completely survived. There were 1 case with superficial necrosis and 2 cases with distal edge partially necrosis And these 3 cases all healed after short time dressing change. I case was lost during follow up,others were followed up for 3 to 18 months ,with an average of 9 months,and none recurred. Conclusion Distally based sural neu- ro-lesser saphenous veno-fasciocutaneous compound flap is a perfect method for the treatment of the lower leg,ankle and foot soft tissue defects because of its reliable blood supplying and simple operation.